Building a clinical ladder for ambulatory care

Finding innovative rewards for nursing service will be integral in meeting the challenges of future shortages of nursing staff. A clinical ladder is one tool worth exploring and perfecting to address those challenges. Exploration of a case study demonstrates a method for developing a clinical ladder. Steps and pitfalls in developing a clinical path are illustrated. Future uses, benefits, and opportunities for clinical ladders are suggested.     

Repeat‐Sales Indexes: Estimation without Assuming that Errors in Asset Returns Are Independently Distributed

This article proposes an alternative specification for the second stage of the Case‐Shiller repeat‐sales method. This specification is based on serial correlation in the deviations from the mean one‐period returns on the underlying individual assets, whereas the original Case‐Shiller method assumes that the deviations from mean returns by the underlying individual assets are i.i.d. The methodology proposed in this article is easy to implement and provides more accurate estimates of the standard errors of returns under serial correlation. The repeat‐sales methodology is generally used to construct an index of prices or returns for unique, infrequently traded assets such as houses, art and musical instruments, which are likely to be prone to exhibit serial correlation in returns. We demonstrate our methodology on a data set of art prices and on a data set of real estate prices from the city of Amsterdam.     

FAIR TRADE IS COUNTERPRODUCTIVE AND UNFAIR: REJOINDER

This is a rejoinder to a criticism of Henderson (2008 ) by Alastair Smith. Our conclusion is that Henderson's basic case, although nicked around the edges by developments since the original was written, still stands. Moreover, we point out that Smith's criticism of Henderson's point that Fair Trade could help kill the banana actually supports Henderson's case. Finally, Smith's proposed 'trade, not aid' solution does not contradict Henderson (2008 ). Refusing to buy Fair Trade coffee and other products and, instead, buying quality coffee and other products would not reduce trade, as Smith seems to imply.     

Retail Market Power in a Shopping Basket Model of Supermarket Competition

Supermarket retailers typically operate with relatively low margins, suggesting a highly competitive retail environment. However, despite the fact that consumers purchase an entire shopping basket at a time from supermarkets, this evidence is largely based on models of retail competition with single-category purchases. In this paper, we develop and test an empirical model of retail price competition that explicitly accounts for the effect of demand complementarity among items in consumer shopping baskets. Relative to the case where consumers purchase products with independent demands, we demonstrate that equilibrium prices are higher for all items when retailers take demand-complementarity into account. Our findings indicate that non-price strategies intended to encourage complementarity, such as co-merchandising, strategic shelf-positioning, or featuring complementary goods tend to soften price competition, and lead to higher equilibrium prices.     

Cost-effectiveness analysis of sequential biologic therapy with ixekizumab versus secukinumab as first-line treatment of moderate-to-severe psoriasis in the UK

Aims: Patients with psoriasis often undergo treatment with a sequence of biologic agents because of poor/loss of response to initial therapy. With the availability of newer agents like ixekizumab and secukinumab, there is a need for cost-effectiveness analyses to better reflect current clinical practice. This study aimed to assess the cost-effectiveness of a sequence of biologic therapies containing first-line ixekizumab vs first-line secukinumab in patients with moderate-to-severe plaque psoriasis in the UK.

Materials and methods: A Markov model with a lifetime horizon was developed to compare the cost-effectiveness of ixekizumab and secukinumab treatment sequences: ixekizumab → ustekinumab → infliximab → best supportive care (BSC) vs secukinumab → ustekinumab → infliximab → BSC. The model used monthly cycles, and included four health states: trial period, treatment maintenance, BSC, and death. At the end of the trial period, responders transitioned to maintenance therapy; non-responders transitioned to the next biologic in the sequence. An annual discontinuation rate of 20% was assumed for maintenance therapy.

Results: The ixekizumab sequence provided cost savings of £898 (£176,203 vs 177,101) [year 2015 values] and gained 0.03 more quality-adjusted life-years (QALYs: 1.45 vs 1.42) vs the secukinumab sequence over the lifetime horizon. Probabilistic sensitivity analysis showed an 89.8% likelihood that the ixekizumab sequence would be cost-effective at a threshold of £20,000 per QALY gained.

Limitations: The analysis used list prices for drugs rather than confidential, preferentially priced Patient Access Scheme costs. In addition, efficacy input data were based on a network meta-analysis, as there were no head-to-head trials comparing ixekizumab and secukinumab.

Conclusion: First-line treatment with ixekizumab as part of a specific sequential biologic therapy for moderate-to-severe plaque psoriasis in the UK provided slight advantages in cost savings and QALYs gained over a similar treatment sequence initiated with secukinumab. In view of the small magnitude of these differences, factors such as patient preferences (e.g. for number of injections) and long-term safety (e.g. related to time on the market) may also be important for clinical decision-making.     

Twin-killing in some traditional societies: an economic perspective

Historically, some societies around the world killed newborn twins, though the practice was forsaken in the early twentieth century. Anthropologists have proposed different theses: (1) the delivery of twins occurred when the mother cheated on her husband, or committed a great sin, and killing the twins was the penalty, (2) twin-killing was done to assert that human beings were different from animals among which multiple births in the same delivery were seen, (3) twins brought a dilemma to the kinship structure of societies and to cope with it different rules were adopted, twin-killing being the extreme one, (4) twin-killing was a means to face resource stress. We argue that although those interpretations are useful, we can improve the understanding of that phenomenon by adding an identity economics model, where twins are a taboo. Identity economics helps us explain the persistence of the practice and its eventual decline. We make our case with examples from the Igbo of Nigeria.     

The Effect of Time Use in Explaining Male–Female Productivity Differences Among Economists

This study examines the opportunity cost of non‐research responsibilities on research output. Using a sample of early career faculty members who received their Ph.D. in economics, we consider the effect of two dimensions of time use on research output: (1) time allocation, or how time is divided between research and other duties and (2) time concentration, or how research time is distributed during the academic year relative to summer months. This second dimension has not been used in prior studies on research productivity; however, the inherent delays in the publication process as well as start‐up costs may imply that concentrating research time exclusively in the summer months reduces research output. We find that both dimensions of time use are significant predictors of peer‐reviewed publications and that time concentration is a significant predictor of submissions. We find gender differences in both dimensions of time use, which are attributable to gender differences in employment at research institutions and on‐going childcare responsibilities.     

Identification and estimation of Gaussian affine term structure models

This paper develops new results for identification and estimation of Gaussian affine term structure models. We establish that three popular canonical representations are unidentified, and demonstrate how unidentified regions can complicate numerical optimization. A separate contribution of the paper is the proposal of minimum-chi-square estimation as an alternative to MLE. We show that, although it is asymptotically equivalent to MLE, it can be much easier to compute. In some cases, MCSE allows researchers to recognize with certainty whether a given estimate represents a global maximum of the likelihood function and makes feasible the computation of small-sample standard errors.